Dr. John Upledger writes in his textbook, Craniosacral Therapy, “Two very common injuries which adversely influence craniosacral system function, and are often the underlying cause of headache and autonomic dysfunction, are impaction of the sacrum between the ilia, and anterior flexion of the coccyx.” (Pp.148-9.) I recently worked with a patient that demonstrated this relationship very clearly. This 30-year old woman presented with an 8-year history of migraine headaches, neck pain and neck muscle spasms. She had seen many doctors, including neurologists, and had undergone cranial and cervical imaging which were all negative. The headaches had, in recent years, become constant and severe, and were exacerbated by carrying small items such as a light purse on her shoulder, exercise, or exposure to temperature extremes. Her situation became unbearable when, 4 months prior to seeing me, she had her first child. “For the most part I adjusted my life around my limitations,” she said, “but when I had a baby it became too heartbreaking for me not to be able to carry her without experiencing pain. I was beginning to lose hope for myself.” Her headaches could rate anywhere from 7/10 to 9/10 on the visual analog scale, and were located in the suboccipital, temporal, and frontal regions.
When I first met this patient, she revealed a history of a fall down a flight of concrete stairs 12 years prior, which had resulted in a coccyx fracture. As a Physical Therapist, I have the option of training in the evaluation and treatment of pelvic floor dysfunction, including coccygeal positional dysfunction, utilizing a transvaginal or transrectal (i.e. “internal”) approach. This is especially helpful in cases where a flexed or extended coccyx is present, as correction of this dysfunction is far easier when using an internal approach. Having these tools in my “tool box,” combined with Craniosacral techniques, provides me a unique opportunity to help those suffering from headaches that have a dural cause related to tailbone dysfunction.
The patient and I discussed the possible connection between her tailbone injury and her headaches, with a focus on the attachment of the dura to the coccygeal periosteum. I used a model of the sacrum and tailbone, and diagrams of the craniosacral system, to further explain the connection. The patient consented to an external and internal assessment of her tailbone position, to evaluate its role in her condition. Upon assessment, I found that her coccyx was significantly sheared posteriorly at the sacrococcygeal junction, but was also extended, and deviated to the right. The nearby coccygeus muscle on the right side of the coccyx was significantly shortened, and seemed to be reinforcing the R deviation of the coccyx. Through further evaluation I also noted restrictions of the sacrococcygeal and L5/S1 joints, decreased inferior glide of the dura via the sacrum, restrictions at the occipital-cranial base (OCB), and decreased amplitude of the craniosacral rhythm (CSR) at the right OCB. I did not find any specific restrictions of the cranial bones, but noted an overall decreased amplitude of the CSR throughout the cranium.
(Continue to Part 2)